Aetna, Lies, and Prior Authorization

Just this morning Natalie at Aetna insulted their subscriber -- and tried to exploit me -- while wasting everyone’s time. The prior authorization process actually started out well. I made sure the Rite-Aid pharmacist understood that if she facilitated the process by working through I would waive my customary $50 fee for participating. (I am not a contracted provider for any payer.)

I knew there would be trouble when I answered the questions about the patient’s involvement in recovery counseling or other treatment program, neither of which I provide. Aetna promptly notified the patient of the denial, and the patient promptly obtained an appointment with a psychotherapist or counselor. A family member passed the new information back to Aetna, but Aetna, apparently, refused to take the subscribers word for it and demanded that I “update” the “paperwork.”

This morning I talked to Natalie at Aetna. I explained that the patient’s family member had told me the same thing they told Aetna, that I had nothing to add. I also made her aware in no uncertain terms that I am not, and will not become, an agent for Aetna, nor will I act as some kind of private investigator to determine whether the patient actually keeps the appointment or continues to participate in the treatment. I will, however, attempt to communicate with any other treatment provider to coordinate our efforts.

I have no problem with Aetna wanting to make sure the Suboxone I prescribed was indicated before agreeing to pay for the prescription, but providing my "X" DEA number, which implies a diagnosis of opiate dependence, should have sufficed. 

The entire prior authorization wasted time and money. If Aetna does not trust their subscriber and wants to verify the patient’s participation in counseling, they can contact the counselor themselves.

I encourage all prescribers to refuse to allow payers to exploit them, financially or otherwise to serve the company’s purposes

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